Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Am J Hypertens. 2021 Dec 1;34(12):1247-1254. doi: 10.1093/ajh/hpab124.
The present paper will provide an update on the role of sympathetic neural factors in the development and progression of essential hypertension by reviewing data collected in the past 10 years. This will be done by discussing the results of the published studies in which sympathetic neural function in essential hypertension and related disease has been investigated via sophisticated and highly sensitive techniques, such as microneurographic recording of sympathetic nerve traffic and regional norepinephrine spillover. First, the relevance of the pathophysiological background of the neurogenic alterations will be discussed. It will be then examined the behavior of the sympathetic neural function in specific clinical phenotypes, such as resistant hypertension, pseudoresistant hypertension, and hypertensive states displaying elevated resting heart values. This will be followed by a discussion of the main results of the meta-analytic studies examining the behavior of sympathetic nerve traffic in essential hypertension, obesity, metabolic syndrome, and chronic renal failure. The sympathetic effects of renal denervation and carotid baroreceptor stimulation as well as the possible involvement of sympathetic neural factors in the determination of the so-called "residual risk" of the treated hypertensive patients will be finally discussed.
本文将通过回顾过去 10 年收集的数据，更新交感神经因素在原发性高血压发展和进展中的作用。这将通过讨论已发表的研究结果来实现，这些研究通过诸如交感神经流量的微神经记录和区域去甲肾上腺素溢出等复杂且高度敏感的技术，研究了原发性高血压和相关疾病中的交感神经功能。首先，将讨论神经源性改变的病理生理背景的相关性。然后，将检查特定临床表型中交感神经功能的行为，例如难治性高血压、假性难治性高血压和静息心率升高的高血压状态。接下来将讨论检查原发性高血压、肥胖症、代谢综合征和慢性肾衰竭中交感神经流量行为的荟萃分析研究的主要结果。最后将讨论肾去神经支配和颈动脉压力感受器刺激的交感效应，以及交感神经因素在确定治疗高血压患者所谓的“残余风险”中的可能作用。
